The Safety Attitudes Questionnaire as a tool for benchmarking safety culture in the NICU

Abstract

Background: Neonatal intensive care unit (NICU) safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies widely. Associations with clinical outcomes in the adult intensive care unit setting make the SAQ an attractive tool for comparing clinical performance between hospitals. Little information is available on the use of the SAQ for this purpose in the NICU setting.

Objectives: To determine whether the dimensions of safety culture measured by the SAQ give consistent results when used as a NICU performance measure.

Methods: Cross-sectional survey of caregivers in 12 NICUs, using the six scales of the SAQ: teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management and working conditions. NICUs were ranked by quantifying their contribution to overall risk-adjusted variation across the scales. Spearman rank correlation coefficients were used to test for consistency in scale performance. The authors then examined whether performance in the top four NICUs in one scale predicted top four performance in others.

Results: There were 547 respondents in 12 NICUs. Of 15 NICU-level correlations in performance ranking, two were >0.7, seven were between 0.4 and 0.69, and the six remaining were <0.4. The authors found a trend towards significance in comparing the distribution of performance in the top four NICUs across domains with a binomial distribution p=0.051, indicating generally consistent performance across dimensions of safety culture.

Conclusion: A culture of safety permeates many aspects of patient care and organisational functioning. The SAQ may be a useful tool for comparative performance assessments among NICUs.

Figure 1

Distribution of rankings in the top 4 NICUs across scales compared to a binomial distribution. The binomial distribution indicates expected random performance of NICUs across safety culture scales. If actual NICUs are consistently high or poor performers the distribution should be U-shaped. We indeed found an approximate U-shaped distribution among our study sample (χ2 value = 9.43, P = .051).